1. PURPOSE

These Guidelines supplements existing documents that articulate personal, occupational, and environmental health and safety guidelines and protocols that apply to medical students, including:

• Protocol for incidents of medical student workplace injury and exposure to infectious disease in clinical settings
• Learner Mistreatment Guideline
• Guidelines regarding infectious diseases and occupational health for applicants to and learners of the faculty of medicine academic programs
• Respiratory protection policy (“mask-fit policy”) and procedure for University of Toronto Faculty of Medicine undergraduate medical students

These Guidelines addresses personal safety and occupational hazards related to working in the health care environment. Specifically, these Guidelines promotes a safe environment that minimizes the risk of injury or harm at all University of Toronto affiliated teaching sites, provides a protocol to report unsafe or hazardous training conditions, and a mechanism to take corrective action. It identifies the roles and responsibilities that the Academies, clinical sites, and clinical clerkship, and students play in supporting a safe working environment.

These Guidelines are informed by the University of Toronto Health and Safety Policy as well as accreditation Element 5.7 Security, Student Safety, and Disaster Preparedness.

2. PREAMBLE

In the course of their training, medical students may be exposed to risk of personal injury or hazardous agents. The University, its affiliated teaching sites, including hospitals, laboratories and community clinical settings, and medical students are jointly responsible for supporting a culture promoting health and safety and preventing injury and incidents. Although medical students are not employees, when students work in the health care environment, hospital occupational health and safety training, regulations and protection programs are extended to them. Accidents, incidents and environmental exposures occurring during training will be reported and administered according to the reporting policies and procedures of the University, hospital or clinical teaching location.

3. SCOPE

These Guidelines pertain to the following items under the categories:

Personal Safety including:

• Access to secure lockers and call rooms
• Safe travel between call facilities and clinical service location, and to private vehicle or public transportation
• Safety while working in isolated or remote situations including visiting patients in their homes or after hours
• Protection from workplace violence and harassment
• Protection of student’s personal information

Occupational Hazards including:

• Hazardous workplace materials as named in the Occupational Health and Safety Act
• Radiation safety, chemical spills, and environmental exposures
• Infectious diseases that are communicable by contact, needle stick or respiratory mechanisms

4. PERSONAL SAFETY

Responsibility of the Academies, Clinical Sites and Clinical Clerkships:

• Academies, clinical sites, and clinical clerkships share in the responsibility that students are adequately oriented to personal safety risks and policies prior to starting on clinical services.
• Medical students are entitled to secure and private call rooms.
• Medical students are entitled to personal safety programs normally available to hospital staff that promote safe travel between workplace and private vehicles or public transportation.
• Clinical clerkships and clinical sites should train students in their ability to assess personal safety risks specific to each rotation or clinical setting.
• Where safety risks exist, students are not expected to see a patient in hospital, clinic or at home, during regular or after hours, without the presence of a supervisor and security personnel (as required).
• Clinical sites must endeavour to safeguard trainees’ personal information, other than identifying them by name when communicating with patients, staff and families.
• Medical students should obtain training on prevention, management, and reporting of workplace violence, harassment and intimidation.

Responsibility of Students:

• Students must use all necessary personal protective equipment, precautions and safeguards, including back up from supervisors, when engaging in clinical and/or educational experiences.
• Students must exercise judgment and be aware of alternate options when exposing themselves to workplace risks or during travel to and from the clinical site (i.e., driving a personal vehicle when fatigued).
• Students must use caution when offering personal information to patients, families or staff.
• Students must promptly report any safety concerns (e.g. risk of personal safety, fatigue, etc.) to their supervisor.
• Students must participate in training in the prevention and management of workplace violence, intimidation and harassment.

Reporting Protocol and Procedure for Managing Breaches of Personal Safety:

• Students who feel their personal safety or security is threatened should remove themselves immediately from the situation in a professional manner and seek urgent assistance from their supervisor, the institution’s security services, call “Code White”, or 911 where applicable.
• Students identifying a personal safety or security breach must report it to their immediate supervisor, or to the Academy Director/ Medical Education Lead, to allow a resolution of the issue at a local level, and to comply with the site reporting requirements. Students should follow the relevant protocols for the management of workplace violence, intimidation and harassment. Student confidentiality will be maintained in reporting whenever possible.
• The Learner Mistreatment Guideline articulates procedures for University of Toronto medical students to disclose/report incidents of student discrimination, harassment, mistreatment and other incidents of unprofessionalism that they have experienced or witnessed.
• Students in community-based practices or other non-institutional settings should discuss issues or concerns with the supervising faculty member or community-based coordinator or bring any safety concerns to the attention of their Academy Director, Clerkship Course Director, Clerkship Director or Associate Dean, Learner Affairs.
• If the safety issue raised is not resolved at the local level, it must be reported to the Associate Dean, Learner Affairs, who will investigate and may re-direct the issue to the relevant hospital medical education office and/or University office for resolution.
• Pending investigation and resolution of identified concerns: The Clerkship Director and/or Associate Dean, Learner Affairs have the authority to remove students from clinical placements if a risk is seen to be unacceptable.
• As necessary and appropriate, the Associate Dean, Learner Affairs will bring personal safety issues to the Associate Dean, MD Program; Academy Director; and hospital office responsible for safety and security and may involve relevant University Offices for resolution or further consultation.
• The Associate Dean, Learner Affairs may at any time investigate and act upon health and safety systems issues that come to her/his attention by any means, including internal reviews, student/faculty/staff reporting, or police/security intervention. Consideration will be given to the protection of student personal health information and issues potentially pertaining to patient safety, informed by the Personal Health Information Protection Act and Freedom of Information and Protection of Privacy Act.

5. OCCUPATIONAL HAZARDS

Academies, clinical sites, and clinical clerkships share in the responsibility that students are adequately oriented to workplace hazards and safety policies prior to starting on clinical services.

Responsibilities of the Academies, Clinical Clerkships and Clinical Site:

• The Academies, clinical clerkships and clinical sites must ensure medical students are appropriately oriented to current best practices for workplace safety guidelines.
• Training will be provided in WHMIS (Workplace Hazardous Materials Information System).
• Clerkships must have guidelines to address exposures specific to each training site (e.g. radiation safety, hazardous materials), communicate these to medical students at site-specific orientation sessions, and assess trainees for appropriate understanding prior to involvement in activities which may involve potential exposure to hazardous materials.
• Clinical sites must provide the necessary equipment to ensure medical student safety with respect to environmental or infectious exposure.

Responsibilities of the Student:

• Students must participate in required safety sessions as determined by the Academy, clerkship or clinical training site.
• Students must complete WHMIS training before working in clinical settings.
• Students must follow all of the occupational health and safety policies and procedures of the training site including, but not limited to, the appropriate use of personal protective equipment.
• Students must agree to report unsafe training conditions as per the protocol outlined below and in accordance with clinical site policies.
• Students in breach of the occupational health policies of their training site are subject to the procedures by that site consistent with the requirements of the Occupational Health and Safety Act. If attempts to resolve the situation by internal protocols are not successful, it may be brought to the attention of the training site Academy Director/Medical Education Lead.

Reporting Protocol for Workplace Hazard Exposure or Incident

A. During daytime hours while working at an affiliated hospital or site associated with an affiliated hospital:

1. The student should follow post exposure protocols and must go immediately to the Employee/Occupational Health Office of the institution if there are personal health risks associated with the exposure.
2. The student must complete the incident report form as required by the institution’s protocol.
3. The student must report the incident to his/her immediate supervisor.

B. During evenings or weekends or at a training site with no Occupational Health Office:

1. The student must follow immediate post exposure protocols and if there are personal health risks associated with the exposure, go immediately to the nearest emergency room and identify him/herself as medical student at the University of Toronto and request to be seen on an urgent basis.
2. The student must report to the available supervisor, comply with the institution’s protocol for completion of appropriate incident report.